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Wireless video capsule endoscopy

David Cave, MD, PhD
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF


Wireless video endoscopy or video capsule endoscopy (VCE) is a noninvasive technology designed primarily to provide diagnostic imaging of the small intestine, an anatomic site that has proven peculiarly difficult to visualize. Limited views of the esophagus, stomach, and cecum may also be acquired. Images acquired are of excellent resolution and have a 1:8 magnification, which is higher than that of conventional endoscopes. This magnification allows visualization of individual villi. VCE approaches the concept of physiological endoscopy since the capsule moves passively, does not inflate the bowel, and images the mucosa in the collapsed state. Double-ended wireless video capsules have also been developed for the examination of the esophagus and colon.

This topic will review the use of wireless video capsule endoscopy for evaluation of the esophagus, small bowel, and the colon. The general approaches to patients with occult and/or suspected small bowel bleeding are discussed in detail elsewhere. (See "Evaluation of occult gastrointestinal bleeding" and "Evaluation of suspected small bowel bleeding (formerly obscure gastrointestinal bleeding)".)


There are three small bowel capsules (PillCam SB, EndoCapsule, and MiRo capsule) and one esophageal capsule (PillCam ESO) that are available. A colonic capsule is also available in Europe, the United States, and Japan (PillCam Colon). (See 'Colon capsule endoscopy' below.)

The US Food and Drug Administration (FDA) approved the original capsule in August 2001 [1,2]. It was subsequently replaced by the M2A Plus capsule, which has now been renamed the PillCam SB. The PillCam is now in its third generation (PillCam SB3). This version has an improved resolution and a variable frame rate. The frame rate increases to six frames per second when it is moving quickly, as in the duodenal sweep, and slows to two frames per second when moving slowly or when stationary. It has a "suspected blood indicator," which may facilitate identification of bleeding sites, although the clinical value of this feature is unclear since the sensitivity and specificity are poor [3-5]. The latest version of the PillCam software has discontinued the ability to track the location of the capsule within the abdominal cavity because of poor accuracy.

In October 2007, the FDA approved a second small bowel capsule (EndoCapsule). It has similar characteristics to the PillCam SB, but has a charge-coupled device chip instead of a complementary metal-oxide-semiconductor chip. FDA approval was based upon a study of 51 patients with suspected small bowel bleeding who swallowed both the PillCam SB and the EndoCapsule 40 minutes apart in randomized order [6]. The devices were similar, based upon the detection of normal versus abnormal and in diagnostic capability. This study also demonstrated that a capsule does not always travel axially but may tumble. Furthermore, non-axial movement implies incomplete mucosal visualization, one of the limitations of the technology. The original EndoCapsule has been superseded by the EndoCapsule 10, which has also received FDA approval. This device has increased resolution and three-dimensional location software.

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Literature review current through: Nov 2017. | This topic last updated: May 30, 2017.
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